Healthcare Provider Details

I. General information

NPI: 1285895060
Provider Name (Legal Business Name): JENNIFER MENARD PIKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JOANNE MENARD PA-C

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 SETTLERS TRACE BLVD STE 100
LAFAYETTE LA
70508-6061
US

IV. Provider business mailing address

309 SETTLERS TRACE BLVD STE 100
LAFAYETTE LA
70508-6061
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-6065
  • Fax:
Mailing address:
  • Phone: 337-981-6065
  • Fax: 337-266-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.200200
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: